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Mendoza-Hernandez MA, Hernandez-Fuentes GA, Sanchez-Ramirez CA, Rojas-Larios F, Guzman-Esquivel J, Rodriguez-Sanchez IP, Martinez-Fierro ML, Cardenas-Rojas MI, De-Leon-Zaragoza L, Trujillo-Hernandez B, Fuentes-Murguia M, Ochoa-Díaz-López H, Sánchez-Meza K, Delgado-Enciso I. Time‑dependent ROC curve analysis to determine the predictive capacity of seven clinical scales for mortality in patients with COVID‑19: Study of a hospital cohort with very high mortality. Biomed Rep 2024; 20:100. [PMID: 38765855 PMCID: PMC11099607 DOI: 10.3892/br.2024.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/12/2024] [Indexed: 05/22/2024] Open
Abstract
Clinical data from hospital admissions are typically utilized to determine the prognostic capacity of Coronavirus disease 2019 (COVID-19) indices. However, as disease status and severity markers evolve over time, time-dependent receiver operating characteristic (ROC) curve analysis becomes more appropriate. The present analysis assessed predictive power for death at various time points throughout patient hospitalization. In a cohort study involving 515 hospitalized patients (General Hospital Number 1 of Mexican Social Security Institute, Colima, Mexico from February 2021 to December 2022) with COVID-19, seven severity indices [Pneumonia Severity Index (PSI) PaO2/FiO2 arterial oxygen pressure/fraction of inspired oxygen (Kirby index), the Critical Illness Risk Score (COVID-GRAM), the National Early Warning Score 2 (NEWS-2), the quick Sequential Organ Failure Assessment score (qSOFA), the Fibrosis-4 index (FIB-4) and the Viral Pneumonia Mortality Score (MuLBSTA were evaluated using time-dependent ROC curves. Clinical data were collected at admission and at 2, 4, 6 and 8 days into hospitalization. The study calculated the area under the curve (AUC), sensitivity, specificity, and predictive values for each index at these time points. Mortality was 43.9%. Throughout all time points, NEWS-2 demonstrated the highest predictive power for mortality, as indicated by its AUC values. PSI and COVID-GRAM followed, with predictive power increasing as hospitalization duration progressed. Additionally, NEWS-2 exhibited the highest sensitivity (>96% in all periods) but showed low specificity, which increased from 22.9% at admission to 58.1% by day 8. PSI displayed good predictive capacity from admission to day 6 and excellent predictive power at day 8 and its sensitivity remained >80% throughout all periods, with moderate specificity (70.6-77.3%). COVID-GRAM demonstrated good predictive capacity across all periods, with high sensitivity (84.2-87.3%) but low-to-moderate specificity (61.5-67.6%). The qSOFA index initially had poor predictive power upon admission but improved after 4 days. FIB-4 had a statistically significant predictive capacity in all periods (P=0.001), but with limited clinical value (AUC, 0.639-0.698), and with low sensitivity and specificity. MuLBSTA and IKIRBY exhibited low predictive power at admission and no power after 6 days. In conclusion, in COVID-19 patients with high mortality rates, NEWS-2 and PSI consistently exhibited predictive power for death during hospital stay, with PSI demonstrating the best balance between sensitivity and specificity.
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Affiliation(s)
- Martha A. Mendoza-Hernandez
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- COVID Unit, General Hospital Number 1, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | | | | | - Fabian Rojas-Larios
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Jose Guzman-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico
| | - Martha I. Cardenas-Rojas
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | - Luis De-Leon-Zaragoza
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
| | | | - Mercedes Fuentes-Murguia
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Héctor Ochoa-Díaz-López
- Department of Health, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, 29290 Chiapas, Mexico
| | - Karmina Sánchez-Meza
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
| | - Ivan Delgado-Enciso
- Department of Molecular Medicine, School of Medicine, University of Colima, Colima 28040, Mexico
- Department of Research, Colima Cancerology State Institute, IMSS-Bienestar Colima, Colima 28085, Mexico
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Wu Z, Geng N, Liu Z, Pan W, Zhu Y, Shan J, Shi H, Han Y, Ma Y, Liu B. Presepsin as a prognostic biomarker in COVID-19 patients: combining clinical scoring systems and laboratory inflammatory markers for outcome prediction. Virol J 2024; 21:96. [PMID: 38671532 PMCID: PMC11046891 DOI: 10.1186/s12985-024-02367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND There is still limited research on the prognostic value of Presepsin as a biomarker for predicting the outcome of COVID-19 patients. Additionally, research on the combined predictive value of Presepsin with clinical scoring systems and inflammation markers for disease prognosis is lacking. METHODS A total of 226 COVID-19 patients admitted to Beijing Youan Hospital's emergency department from May to November 2022 were screened. Demographic information, laboratory measurements, and blood samples for Presepsin levels were collected upon admission. The predictive value of Presepsin, clinical scoring systems, and inflammation markers for 28-day mortality was analyzed. RESULTS A total of 190 patients were analyzed, 83 (43.7%) were mild, 61 (32.1%) were moderate, and 46 (24.2%) were severe/critically ill. 23 (12.1%) patients died within 28 days. The Presepsin levels in severe/critical patients were significantly higher compared to moderate and mild patients (p < 0.001). Presepsin showed significant predictive value for 28-day mortality in COVID-19 patients, with an area under the ROC curve of 0.828 (95% CI: 0.737-0.920). Clinical scoring systems and inflammation markers also played a significant role in predicting 28-day outcomes. After Cox regression adjustment, Presepsin, qSOFA, NEWS2, PSI, CURB-65, CRP, NLR, CAR, and LCR were identified as independent predictors of 28-day mortality in COVID-19 patients (all p-values < 0.05). Combining Presepsin with clinical scoring systems and inflammation markers further enhanced the predictive value for patient prognosis. CONCLUSION Presepsin is a favorable indicator for the prognosis of COVID-19 patients, and its combination with clinical scoring systems and inflammation markers improved prognostic assessment.
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Affiliation(s)
- Zhipeng Wu
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing City, 100069, People's Republic of China
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, People's Republic of China
| | - Nan Geng
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Zhao Liu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Wen Pan
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Yueke Zhu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Jing Shan
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China
| | - Hongbo Shi
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Ying Han
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Yingmin Ma
- Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing City, 100069, People's Republic of China.
- Beijing Institute of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, People's Republic of China.
| | - Bo Liu
- Department of Emergency Medicine, Beijing Youan Hospital, Capital Medical University, Beijing City, 100069, People's Republic of China.
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3
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Deva A, Juthani R, Kugan E, Balamurugan N, Ayyan M. Utility of ED triage tools in predicting the need for intensive respiratory or vasopressor support in adult patients with COVID-19. Am J Emerg Med 2024; 78:151-156. [PMID: 38281375 DOI: 10.1016/j.ajem.2024.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Serum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65 can be used to triage patients in the Emergency Department. They can be used to predict patients with the highest risk of seven-day mortality and need for intensive respiratory or vasopressor support (IRVS). PURPOSE The primary purpose was to find the score with the highest AUC in predicting IRVS and mortality at seven days. Additional objective was to find out any independent factors associated with IRVS and mortality. METHODS The data of adult patients who presented to the Emergency Department (ED) between April 1, 2021 and June 30, 2021 were collected. The WHO score, CRB-65, DS-CRB 65, PMEWS, NEWS2, and qSOFA score were calculated for all patients. Statistical analysis was done and an ROC curve was calculated for all the tools for mortality and need for IRVS at seven days. FINDINGS 677 patients presented to the Emergency Department with COVID-19 during the period above. Presence of Diabetes Mellitus (p = 0.001), Hypertension (p = 0.001), and chronic kidney disease(CKD) (p = 0.04) was significantly associated with need for IRVS. Age, duration of symptoms, pulse rate, respiratory rate, room air saturation, mental status at admission, and time to IRVS need were identified as independent predictors of in-hospital mortality. The longer the time to IRVS need from ED arrival, the higher the likelihood of mortality. PMEWS (0.830) had the highest AUC, followed by NEWS2 (0.805). A PMEWS cut-off of 6.5 was 74.2% sensitive and 78.3% specific in predicting the need for IRVS. ROC analysis to predict 7-day mortality showed that PMEWS had an AUC of 0.802 (0.766-0.839). QSOFA performed poorly in predicting IRVS (AUC 0.645) and 7-day mortality (AUC 0.677). CONCLUSION PMEWS may be used for triaging patients presenting to the Emergency Department with COVID-19 and accurately predicts the need for IRVS and seven day mortality.
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Affiliation(s)
- Anandhi Deva
- Department of Emergency Medicine & Trauma, JIPMER, Puducherry, India
| | - Ronit Juthani
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, United States.
| | - Ezhil Kugan
- Department of Emergency Medicine & Trauma, JIPMER, Puducherry, India
| | - N Balamurugan
- Department of Emergency Medicine & Trauma, JIPMER, Puducherry, India
| | - Manu Ayyan
- Department of Emergency Medicine & Trauma, JIPMER, Puducherry, India
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Dilokpattanamongkol P, Yan C, Jayanama K, Ngamjanyaporn P, Sungkanuparph S, Rotjanapan P. Impact of vitamin D supplementation on the clinical outcomes of COVID-19 pneumonia patients: a single-center randomized controlled trial. BMC Complement Med Ther 2024; 24:97. [PMID: 38383361 PMCID: PMC10880207 DOI: 10.1186/s12906-024-04393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Vitamin D supplementation for infectious diseases has been discussed, but its role in COVID-19 is unclear. Therefore, this study examined the clinical outcomes of COVID-19 pneumonia patients who received vitamin D supplementation. METHODS This prospective, open-label, randomized controlled trial was conducted in a university hospital between July 2020 and March 2022. The inclusion criteria were patients aged ≥ 18 years with COVID-19 pneumonia patients. The patients were randomized into two groups: an intervention group receiving vitamin D supplementation (alfacalcidol, two mcg orally daily) until discharge and a control group. The clinical outcomes were pneumonia treatment duration, length of hospital stay, and change in pneumonia severity index between enrollment and discharge. Subgroup analysis was conducted for supplemental oxygen use, high-dose corticosteroid administration, evidence of lymphopenia, C-reactive protein concentration, and total serum vitamin D concentration. Adverse events were monitored. RESULTS Two hundred ninety-four patients were recruited (147 per group). The two groups did not differ in pneumonia treatment duration to discharge (p = 0.788) or length of hospital stay (p = 0.614). The reduction in the pneumonia severity index between enrollment and discharge was more significant in the intervention group (p = 0.007); a significant decrease was also observed among patients who had C-reactive protein > 30 mg/L (p < 0.001). No adverse reactions were recorded. CONCLUSIONS Adding active vitamin D to standard treatment may benefit COVID-19 pneumonia patients who require supplemental oxygen or high-dose corticosteroid therapy or who have high C-reactive protein concentrations (> 30 mg/L) upon treatment initiation. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20210906005 (retrospectively registered, 6 September 2021).
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Affiliation(s)
| | - Chadakan Yan
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Pintip Ngamjanyaporn
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Porpon Rotjanapan
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Nikzad Jamnani A, Gholipour Baradari A, Kargar-soleimanabad S, Javaheri S. Predictive performance of SOFA (Sequential Organ Failure Assessment) and qSOFA (quick Sequential Organ Failure Assessment) for in-hospital mortality in ICU patients with COVID-19 of referral center in the north of Iran a retrospective study. Ann Med Surg (Lond) 2023; 85:5414-5419. [PMID: 37915640 PMCID: PMC10617872 DOI: 10.1097/ms9.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Patients diagnosed with Coronavirus disease 2019 exhibit varied clinical outcomes, with a reported mortality rate exceeding 30% in those requiring admission to the ICU. The objective of this study was to assess the predictive capacity of Sequential Organ Failure Assessment (SOFA) and quick Sequential Organ Failure Assessment (qSOFA) scores in determining mortality risk among severe COVID-19 patients. Method and materials This retrospective study was performed by analyzing the data of patients with COVID-19 who were hospitalized in the ICUs. Data collection of the parameters required to calculate the SOFA and qSOFA Scores were extracted from patient's medical records. All data analysis was performed using SPSS V.25. Significance level considered as P less than 0.05. Findings In this study, 258 patients were included. The results showed that the subjects ranged in age from 21 to 98 years with a mean and SD of 62.7±15.6. Of all patients, 127 (49.2%) were female and the rest were male. The mortality rate was 102 (39.5%). The underlying disease of diabetes mellitus with an odds ratio of 1.81 (CI=1.02-3.22) had a significant effect on mortality. In addition, a significant correlation was obtained between admission duration and SOFA score (r=0.147, P=0.018). The SOFA had a very high accuracy of 0.941 and at the cut-off point less than 5 had a sensitivity and specificity of 91.2% and 82.7%. In addition, qSOFA had high accuracy (0.914) and a sensitivity and specificity of 87.3% and 91.7% at the optimal cutting point of greater than 1. Conclusion The findings of present study illustrated that deceased COVID-19 patients admitted to the ICU had higher scores on both SOFA and qSOFA scales than surviving patients. Also, both scales have high sensitivity and specificity for anticipating of mortality in these patients. The underlying diabetes mellitus was associated with an increase in patient mortality.
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Affiliation(s)
| | | | | | - Sepehr Javaheri
- Medical Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Casas-Rojo JM, Ventura PS, Antón Santos JM, de Latierro AO, Arévalo-Lorido JC, Mauri M, Rubio-Rivas M, González-Vega R, Giner-Galvañ V, Otero Perpiñá B, Fonseca-Aizpuru E, Muiño A, Del Corral-Beamonte E, Gómez-Huelgas R, Arnalich-Fernández F, Llorente Barrio M, Sancha-Lloret A, Rábago Lorite I, Loureiro-Amigo J, Pintos-Martínez S, García-Sardón E, Montaño-Martínez A, Rojano-Rivero MG, Ramos-Rincón JM, López-Escobar A. Improving prediction of COVID-19 mortality using machine learning in the Spanish SEMI-COVID-19 registry. Intern Emerg Med 2023; 18:1711-1722. [PMID: 37349618 DOI: 10.1007/s11739-023-03338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
COVID-19 is responsible for high mortality, but robust machine learning-based predictors of mortality are lacking. To generate a model for predicting mortality in patients hospitalized with COVID-19 using Gradient Boosting Decision Trees (GBDT). The Spanish SEMI-COVID-19 registry includes 24,514 pseudo-anonymized cases of patients hospitalized with COVID-19 from 1 February 2020 to 5 December 2021. This registry was used as a GBDT machine learning model, employing the CatBoost and BorutaShap classifier to select the most relevant indicators and generate a mortality prediction model by risk level, ranging from 0 to 1. The model was validated by separating patients according to admission date, using the period 1 February to 31 December 2020 (first and second waves, pre-vaccination period) for training, and 1 January to 30 November 2021 (vaccination period) for the test group. An ensemble of ten models with different random seeds was constructed, separating 80% of the patients for training and 20% from the end of the training period for cross-validation. The area under the receiver operating characteristics curve (AUC) was used as a performance metric. Clinical and laboratory data from 23,983 patients were analyzed. CatBoost mortality prediction models achieved an AUC performance of 84.76 (standard deviation 0.45) for patients in the test group (potentially vaccinated patients not included in model training) using 16 features. The performance of the 16-parameter GBDT model for predicting COVID-19 hospital mortality, although requiring a relatively large number of predictors, shows a high predictive capacity.
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Affiliation(s)
- José-Manuel Casas-Rojo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, 28981, Madrid, Spain
| | - Paula Sol Ventura
- Department of Pediatric Endocrinology, Hospital HM Nens, HM Hospitales, 08009, Barcelona, Spain
| | | | | | | | - Marc Mauri
- Data Scientist, Kaizen AI, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío González-Vega
- Internal Medicine Department, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Vicente Giner-Galvañ
- Internal Medicine Department, Hospital Universitario San Juan. San Juan de Alicante, Alicante, Spain
| | | | - Eva Fonseca-Aizpuru
- Internal Medicine Department, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Antonio Muiño
- Internal Medicine Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | | | | | | | - Isabel Rábago Lorite
- Internal Medicine Department, Hospital Universitario Infanta Sofía. San Sebastián de los Reyes, Madrid, Spain
| | - José Loureiro-Amigo
- Internal Medicine Department, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Santiago Pintos-Martínez
- Internal Medicine Department, Hospital Universitario de Sagunto, Puerto de Sagunto, Valencia, Spain
| | - Eva García-Sardón
- Internal Medicine Department, Hospital Universitario de Cáceres, Cáceres, Spain
| | | | | | | | - Alejandro López-Escobar
- Pediatrics Department, Clinical Research Unit, Hospital Universitario Vithas Madrid La Milagrosa, Fundación Vithas, Madrid, Spain.
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Horváth-Szalai Z, Jakabfi-Csepregi R, Szirmay B, Ragán D, Simon G, Kovács-Ábrahám Z, Szabó P, Sipos D, Péterfalvi Á, Miseta A, Csontos C, Kőszegi T, Tóth I. Serum Total Antioxidant Capacity (TAC) and TAC/Lymphocyte Ratio as Promising Predictive Markers in COVID-19. Int J Mol Sci 2023; 24:12935. [PMID: 37629114 PMCID: PMC10454395 DOI: 10.3390/ijms241612935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
SARS-CoV-2 infection might cause a critical disease, and patients' follow-up is based on multiple parameters. Oxidative stress is one of the key factors in the pathogenesis of COVID-19 suggesting that its level could be a prognostic marker. Therefore, we elucidated the predictive value of the serum non-enzymatic total antioxidant capacity (TAC) and that of the newly introduced TAC/lymphocyte ratio in COVID-19. We included 61 COVID-19 (n = 27 ward, n = 34 intensive care unit, ICU) patients and 29 controls in our study. Serum TAC on admission was measured by an enhanced chemiluminescence (ECL) microplate assay previously validated by our research group. TAC levels were higher (p < 0.01) in ICU (median: 407.88 µmol/L) than in ward patients (315.44 µmol/L) and controls (296.60 µmol/L). Besides the classical parameters, both the TAC/lymphocyte ratio and TAC had significant predictive values regarding the severity (AUC-ROC for the TAC/lymphocyte ratio: 0.811; for TAC: 0.728) and acute kidney injury (AUC-ROC for the TAC/lymphocyte ratio: 0.747; for TAC: 0.733) in COVID-19. Moreover, the TAC/lymphocyte ratio had significant predictive value regarding mortality (AUC-ROC: 0.752). Serum TAC and the TAC/lymphocyte ratio might offer valuable information regarding the severity of COVID-19. TAC measured by our ECL microplate assay serves as a promising marker for the prediction of systemic inflammatory diseases.
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Affiliation(s)
- Zoltán Horváth-Szalai
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
- János Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Rita Jakabfi-Csepregi
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
- János Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Balázs Szirmay
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
- János Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Dániel Ragán
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
- János Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Gerda Simon
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary; (G.S.); (Z.K.-Á.); (P.S.); (C.C.); (I.T.)
| | - Zoltán Kovács-Ábrahám
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary; (G.S.); (Z.K.-Á.); (P.S.); (C.C.); (I.T.)
| | - Péter Szabó
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary; (G.S.); (Z.K.-Á.); (P.S.); (C.C.); (I.T.)
| | - Dávid Sipos
- 1st Department of Medicine, Division of Infectious Diseases, Medical School, University of Pécs, 7624 Pécs, Hungary;
| | - Ágnes Péterfalvi
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
| | - Attila Miseta
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
| | - Csaba Csontos
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary; (G.S.); (Z.K.-Á.); (P.S.); (C.C.); (I.T.)
| | - Tamás Kőszegi
- Department of Laboratory Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary; (R.J.-C.); (B.S.); (D.R.); (Á.P.); (A.M.)
- János Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Ildikó Tóth
- Department of Anaesthesiology and Intensive Therapy, Medical School, University of Pécs, 7624 Pécs, Hungary; (G.S.); (Z.K.-Á.); (P.S.); (C.C.); (I.T.)
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Mateos-Arroyo JA, Zaragoza-García I, Sánchez-Gómez R, Posada-Moreno P, Ortuño-Soriano I. Validation of the Barthel Index as a Predictor of In-Hospital Mortality among COVID-19 Patients. Healthcare (Basel) 2023; 11:healthcare11091338. [PMID: 37174880 PMCID: PMC10178780 DOI: 10.3390/healthcare11091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
In order to predict the high mortality due to COVID-19, simple, useful and remote instruments are required. To assess the validity of the baseline Barthel Index score as a predictor of in-hospital mortality among COVID-19 patients, a validation study of a clinical prediction tool in a cohort of patients with COVID-19 was conducted. The primary variable was mortality and the Barthel Index was the main explanatory variable. Demographic, clinical and laboratory variables were collected. Other mortality predictor scores were also assessed: Pneumonia Severity Index, CURB-65 and A-DROP. The Receiver Operating Characteristic Area under the Curve (ROC AUC), sensitivity and specificity were calculated for both the Barthel Index and the other predictor scores. An analysis of the association between the main variables was conducted, adjusting by means of three multivariate models. Three hundred and twelve patients were studied. Mortality was 16.4%. A mortality Odds Ratio (OR) of 5.95 was associated with patients with a Barthel Index ≤ 90. The model number 3 was developed to predict in-hospital mortality before COVID-19 infection occurs. It exhibits an OR of 3.44, a ROC AUC of 0.792, a sensitivity of 74.5% and a specificity of 73.9%. The Baseline Barthel Index proved useful in our population as a predictor of in-hospital mortality due to COVID-19.
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Affiliation(s)
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Rubén Sánchez-Gómez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain
- FIBHCSC, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Paloma Posada-Moreno
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain
- FIBHCSC, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Ismael Ortuño-Soriano
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain
- FIBHCSC, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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9
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Richter T, Tesch F, Schmitt J, Koschel D, Kolditz M. Validation of the qSOFA and CRB-65 in SARS-CoV-2-infected community-acquired pneumonia. ERJ Open Res 2023; 9:00168-2023. [PMID: 37337510 PMCID: PMC10105511 DOI: 10.1183/23120541.00168-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 06/21/2023] Open
Abstract
Rationale Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) and CRB-65 (confusion, respiratory rate, blood pressure and age (≥65 years)) risk scores have not been widely evaluated in patients with SARS-CoV-2-positive compared to SARS-CoV-2-negative community-acquired pneumonia (CAP). The aim of the present study was to validate the qSOFA(-65) and CRB-65 scores in a large cohort of SARS-CoV-2-positive and SARS-CoV-2-negative CAP patients. Methods We included all cases with CAP hospitalised in 2020 from the German nationwide mandatory quality assurance programme and compared cases with SARS-CoV-2 infection to cases without. We excluded cases with unclear SARS-CoV-2 infection state, transferred to another hospital or on mechanical ventilation during admission. Predefined outcomes were hospital mortality and need for mechanical ventilation. Results Among 68 594 SARS-CoV-2-positive patients, hospital mortality (22.7%) and mechanical ventilation (14.9%) were significantly higher when compared to 167 880 SARS-CoV-2-negative patients (15.7% and 9.2%, respectively). All CRB-65 and qSOFA criteria were associated with both outcomes, and age dominated mortality prediction in SARS-CoV-2 (risk ratio >9). Scores including the age criterion had higher area under the curve (AUCs) for mortality in SARS-CoV-2-positive patients (e.g. CRB-65 AUC 0.76) compared to SARS-CoV-2 negative patients (AUC 0.68), and negative predictive value was highest for qSOFA-65=0 (98.2%). Sensitivity for mechanical ventilation prediction was poor with all scores (AUCs 0.59-0.62), and negative predictive values were insufficient (qSOFA-65=0 missed 1490 out of 10 198 patients (∼15%) with mechanical ventilation). Results were similar when excluding frail and palliative patients. Conclusions Hospital mortality and mechanical ventilation rates were higher in SARS-CoV-2-positive than SARS-CoV-2-negative CAP. For SARS-CoV-2-positive CAP, the CRB-65 and qSOFA-65 scores showed adequate prediction of mortality but not of mechanical ventilation.
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Affiliation(s)
- Tina Richter
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Falko Tesch
- Dresden University Centre for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Dresden University Centre for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dirk Koschel
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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10
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Validation of the COVID-19-12O score for predicting readmissions/revisits in patients with SARS-CoV-2 pneumonia discharged from the emergency department. Rev Clin Esp 2023; 223:244-249. [PMID: 36870418 PMCID: PMC9979700 DOI: 10.1016/j.rceng.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
OBJECTIVE The COVID-19-12O-score has been validated to determine the risk of respiratory failure in patients hospitalized for COVID-19. Our study aims to assess whether the score is effective in patients with SARS-CoV-2 pneumonia discharged from a hospital emergency department (HED) to predict readmission and revisit. METHOD Retrospective cohort of patients with SARS-CoV-2 pneumonia discharged consecutively from an HUS of a tertiary hospital, from January 7 to February 17, 2021, where we applied the COVID-19-12O -score, with a cut-off point of 9 points to define the risk of admission or revisit. The primary outcome variable was revisit with or without hospital readmission after 30 days of discharge from HUS. RESULTS We included 77 patients, with a median age of 59 years, 63.6% men and Charlson index of 2. 9.1% had an emergency room revisit and 15.3% had a deferred hospital admission. The relative risk (RR) for emergency journal was 0.46 (0.04-4.62, 95% CI, p=0.452), and the RR for hospital readmission was 6.88 (1.20-39.49, 95% CI, p<0.005). CONCLUSIONS The COVID-19-12O -score is effective in determining the risk of hospital readmission in patients discharged from HED with SARS-CoV-2 pneumonia, but is not useful for assessing the risk of revisit.
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11
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Karanth Marsur Prabhakar S, Ramaswamy S, Basavarajachar V, Chakraborty A, Shivananjiah A, Chikkavenkatappa N. Clinical and Laboratory Predictors of Mortality in Severe COVID-19 Pneumonia: A Retrospective Study from India. THORACIC RESEARCH AND PRACTICE 2023; 24:53-60. [PMID: 37503640 PMCID: PMC10332473 DOI: 10.5152/thoracrespract.2023.22029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/05/2022] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Wide arrays of laboratory parameters have been proposed by many studies for prognosis in COVID-19 patients. In this study, we wanted to determine if the International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score in addition to certain clinical and laboratory parameters would help in predicting mortality. We wanted to determine if a greater severity score on chest x-ray at presentation translated to poor patient outcomes using the COVID-19 chest radiography score. MATERIAL AND METHODS This retrospective study was conducted at SDS TRC and Rajiv Gandhi Institute of chest diseases, Bangalore from March 2021 to June 2021. This study included 202 real-time-polymerase chain reaction-positive COVID-19 patients aged above 18 years admitted to the intensive care unit of our hospital. Demographic characteristics and baseline hematological and inflammatory markers (serum C-reactive protein, lactate dehydrogenase, troponin-I, ferritin, and d-dimer) were collected. Radiological severity on a chest x-ray was assessed using the validated COVID-19 chest radiography score. The International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was assigned to each patient within 24 hours of intensive care unit admission. Outcome studied was in-hospital mortality. RESULTS The overall mortality was 54.9% (111 cases). Age more than 50 years, >4 days of symptoms, peripheral oxygen saturation/ fraction of inspired oxygen ratio less than 200, elevated serum lactate dehydrogenase >398.5 IU/L, and hypoalbuminemia (<2.95 g/dL) were detected as independent predictors of mortality. A significant correlation of risk stratification with mortality (P = .057) was seen with International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score. There was no significant correlation between the COVID-19 chest radiography score and mortality. CONCLUSION Age >50 years, peripheral oxygen saturation/fraction of inspired oxygen ratio <200, mean symptom duration of >4 days, elevated serum lactate dehydrogenase, and hypoalbuminemia are independent predictors of mortality in severe COVID-19 pneumonia. International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was different in the survivors and deceased.
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Affiliation(s)
- Swathi Karanth Marsur Prabhakar
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Swapna Ramaswamy
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Vanitha Basavarajachar
- The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Projects, Swami Vivekananda Youth Movement, Bangalore, Karnataka
| | - Anushree Chakraborty
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Akshata Shivananjiah
- Department of Pulmonary Medicine, Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
| | - Nagaraja Chikkavenkatappa
- Shanthabai Devarao Shivaram Tuberculosis Research Center & Rajiv Gandhi Institute of Chest Diseases, Bangalore, Karnataka
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12
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Espinosa B, Ruso N, Ramos-Rincón J, Moreno-Pérez Ó, Llorens P. [Validation of the COVID-19-12O scale for predicting readmissions/revisits in patients with SARS-CoV-2 pneumonia discharged from the emergency department]. Rev Clin Esp 2023; 223:244-249. [PMID: 36713824 PMCID: PMC9874049 DOI: 10.1016/j.rce.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/08/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The COVID-19-12O scale has been validated for determining the risk of respiratory failure in patients hospitalized due to COVID-19. This study aims to assess whether the scale is effective for predicting readmissions and revisits in patients with SARS-CoV-2 pneumonia discharged from a hospital emergency department (HED). METHOD This work is a retrospective cohort of consecutive patients with SARS-CoV-2 pneumonia discharged from the HED of a tertiary hospital from January 7 to February 17, 2021. The COVID-19-12O scale with a cut-off point of nine points was used to define the risk of admissions or revisits. The primary outcome variable was a revisit with or without hospital readmission after 30 days of discharge from the HED. RESULTS Seventy-seven patients were included. The median age was 59 years, 63.6% were men, and the Charlson Comorbidity Index was 2. A total of 9.1% had an emergency room revisit and 15.3% had a deferred hospital admission. The relative risk (RR) for an HED revisit was 0.46 (0.04-4.62, 95% CI p=0.452) and the RR for hospital readmission was 6.88 (1.20-39.49, 95% CI, p<0.005). CONCLUSIONS The COVID-19-12O scale is effective in determining the risk of hospital readmission in patients discharged from an HED with SARS-CoV-2 pneumonia, but is not useful for assessing the risk of revisit.
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Affiliation(s)
- B. Espinosa
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Autor para correspondencia
| | - N. Ruso
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España
| | - J.M. Ramos-Rincón
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis, Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España
| | - Ó. Moreno-Pérez
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España,Servicio de Endocrinología, Hospital General Universitario Dr. Balmis, Alicante, España
| | - P. Llorens
- Servicio de Urgencias, Hospital General Universitario Dr. Balmis, Alicante, España,Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Sant Joan d’Alacant, Alicante, España
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13
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Zamani M, Heydari F, Abbasi S, Shirani K, Masoumi B, Majidinejad S, Sadeghi-Aliabadi M, Arbab M. Predictive performance of qSOFA in confirmed COVID-19 patients presenting to the emergency department. Tzu Chi Med J 2023. [DOI: 10.4103/tcmj.tcmj_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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14
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Eldaboosy S, Almoosa Z, Saad M, Al Abdullah M, Farouk A, Awad A, Mahdy W, Abdelsalam E, Nour SO, Makled S, Shaarawy A, Kanany H, Qarah S, Kabil A. Comparison Between Physiological Scores SIPF, CURB-65, and APACHE II as Predictors of Prognosis and Mortality in Hospitalized Patients with COVID-19 Pneumonia: A Multicenter Study, Saudi Arabia. Infect Drug Resist 2022; 15:7619-7630. [PMID: 36582451 PMCID: PMC9793736 DOI: 10.2147/idr.s395095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background A coronavirus pandemic (COVID-19) is associated with catastrophic effects on the world with high morbidity and mortality. We aimed to evaluate the accuracy of physiological shock index (SIPF) (shock index and hypoxemia), CURB -65, acute physiology, and chronic health assessment II (APACHE II) as predictors of prognosis and in-hospital mortality in patients with COVID-19 pneumonia. Methods In Saudi Arabia, a multicenter retrospective study was conducted on hospitalized adult patients confirmed to have COVID-19 pneumonia. Information needed to calculate SIPF, CURB-65, and APACHE II scores were obtained from medical records within 24 hours of admission. Results The study included 1131 COVID-19 patients who met the inclusion criteria. They were divided into two groups: (A) the ICU group (n=340; 30.1%) and (B) the ward group (n=791; 69.9%). The most common concomitant diseases of patients at initial ICU admission were hypertension (71.5%) and diabetes (62.4%), and most of them were men (63.8%). The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001). The SIPF score showed a significantly higher ability to predict both ICU admission and mortality in patients with COVID-19 pneumonia compared with APACHE II and CURB -65; (AUC 0.89 vs 0.87; p < 0.001) and (AUC 0.89 vs 0.84; p < 0.001) for ICU admission and (AUC 0.90 vs 0.65; p < 0.001) and (AUC 0.90 vs 0.80; p < 0.001) for mortality, respectively. Conclusion The ability of the SIPF score to predict ICU admission and mortality in COVID-19 pneumonia is higher than that of APACHE II and CURB-65. The overall mortality was 18.7%, and the mortality rate was higher in the ICU group than in the ward group (39.4% vs 9.6%; p < 0.001).
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Affiliation(s)
- Safwat Eldaboosy
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Department of Pulmonary Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Zainab Almoosa
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Mustafa Saad
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Mohammad Al Abdullah
- Department of Infectious Diseases, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Abdallah Farouk
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Critical Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Amgad Awad
- Department of Nephrology and internal Medicine, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Waheed Mahdy
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia,Department of Chest Diseases, Banha Faculty of Medicine, Banha, Egypt
| | - Eman Abdelsalam
- Department of Internal Medicine, Al-Azhar Faculty of Medicine for Girls, Cairo, Egypt,Department of Internal Medicine, King Khalid Hospital, Hail, Saudi Arabia
| | - Sameh O Nour
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Sameh Makled
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shaarawy
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hatem Kanany
- Department of Anesthesia and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Samer Qarah
- Department of Critical Care, Almoosa Specialist Hospital, Al Ahsa, Saudi Arabia
| | - Ahmed Kabil
- Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt,Correspondence: Ahmed Kabil, Department of Chest diseases, Al-Azhar University, Cairo, Egypt, Tel +201006396601, Email
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15
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Zhang Y, Han J, Sun F, Guo Y, Guo Y, Zhu H, Long F, Xia Z, Mao S, Zhao H, Ge Z, Yu J, Zhang Y, Qin L, Ma K, Mao R, Zhang J. A practical scoring model to predict the occurrence of critical illness in hospitalized patients with SARS-CoV-2 omicron infection. Front Microbiol 2022; 13:1031231. [PMID: 36601398 PMCID: PMC9806124 DOI: 10.3389/fmicb.2022.1031231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Background The variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged repeatedly, especially the Omicron strain which is extremely infectious, so early identification of patients who may develop critical illness will aid in delivering proper treatment and optimizing use of resources. We aimed to develop and validate a practical scoring model at hospital admission for predicting which patients with Omicron infection will develop critical illness. Methods A total of 2,459 patients with Omicron infection were enrolled in this retrospective study. Univariate and multivariate logistic regression analysis were performed to evaluate predictors associated with critical illness. Moreover, the area under the receiver operating characteristic curve (AUROC), continuous net reclassification improvement, and integrated discrimination index were assessed. Results The derivation cohort included 1721 patients and the validation cohort included 738 patients. A total of 98 patients developed critical illness. Thirteen variables were independent predictive factors and were included in the risk score: age > 65, C-reactive protein > 10 mg/L, lactate dehydrogenase > 250 U/L, lymphocyte < 0.8*10^9/L, white blood cell > 10*10^9/L, Oxygen saturation < 90%, malignancy, chronic kidney disease, chronic cardiac disease, chronic obstructive pulmonary disease, diabetes, cerebrovascular disease, and non-vaccination. AUROC in the derivation cohort and validation cohort were 0.926 (95% CI, 0.903-0.948) and 0.907 (95% CI, 0.860-0.955), respectively. Moreover, the critical illness risk scoring model had the highest AUROC compared with CURB-65, sequential organ failure assessment (SOFA) and 4C mortality scores, and always obtained more net benefit. Conclusion The risk scoring model based on the characteristics of patients at the time of admission to the hospital may help medical practitioners to identify critically ill patients and take prompt measures.
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Affiliation(s)
- Yao Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiajia Han
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Sun
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yue Guo
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifei Guo
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Haoxiang Zhu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Long
- Department of Respiratory Medicine, Huashan Hospital North, Fudan University, Shanghai, China
| | - Zhijie Xia
- Department of Emergency and Acute Critical Care, Huashan Hospital North, Fudan University, Shanghai, China
| | - Shanlin Mao
- Department of Emergency and Acute Critical Care, Huashan Hospital North, Fudan University, Shanghai, China
| | - Hui Zhao
- Department of Emergency and Acute Critical Care, Huashan Hospital North, Fudan University, Shanghai, China
| | - Zi Ge
- Department of Emergency and Acute Critical Care, Huashan Hospital North, Fudan University, Shanghai, China
| | - Jie Yu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongmei Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China
| | - Lunxiu Qin
- Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, China
| | - Ke Ma
- Department of Emergency and Acute Critical Care, Huashan Hospital North, Fudan University, Shanghai, China,*Correspondence: Ke Ma,
| | - Richeng Mao
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China,Richeng Mao,
| | - Jiming Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China,Shanghai Institute of Infectious Diseases and Biosecurity, Key Laboratory of Medical Molecular Virology (MOE/MOH), Shanghai Medical College, Fudan University, Shanghai, China,Department of Infectious Diseases, Jing’An Branch of Huashan Hospital, Fudan University, Shanghai, China,Jiming Zhang,
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16
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Toker İ, Kılınç-Toker A, Turunç-Özdemir A, Altuntaş M. Comparison of CURB-65 Pneumonia Severity Score, Quick COVID-19 Severity Index, and Brescia-COVID Respiratory Severity Scale in Emergently Hospitalized COVID-19 Patients with Pneumonia. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:244-251. [PMID: 38633713 PMCID: PMC10985812 DOI: 10.36519/idcm.2022.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/06/2022] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to assess the performance of the CURB-65, the quick COVID-19 severity index (qCSI), and the Brescia-COVID respiratory severity scale (BCRSS) scores in predicting ICU (intensive care unit) hospitalization and in-hospital mortality in emergently hospitalized patients with COVID-19 pneumonia. Materials and Methods We retrospectively reviewed the emergently hospitalized 258 patients with COVID-19 pneumonia consecutively. The required sample size was calculated to compare the areas under the two ROC (receiver operating characteristic) curves (AUC) using the MedCalc 20.0 program (MedCalc Software Ltd., Ostend, Belgium). In addition, we actualized ROC analyses of the CURB-65, the qCSI, and the BCRSS scores and compared the ROC curves of these three scores. Results The median age of the patients was 73, and 63.6% (n=164) were male. Of 258 patients, 29.5% (n=76) were hospitalized in the intensive care unit (ICU), and 15.9% (n=41) died. The CURB-65 and the qCSI scores predicted ICU admission at a moderate level (p≤0.001; AUC values were 0.743 and 0.723, respectively). However, the predictive effect of the BCRSS score for ICU admission was lower (p≤0.001; AUC value was 0.667). The CURB-65 predicted in-hospital mortality at a moderate level ( p≤0.001; AUC value was 0.762). However, the predictive effect of the qCSI and the BCRSS scores for in-hospital mortality were lower ( p≤0.001 and p=0.012, respectively; AUC values were 0.655 and 0.612, respectively). Conclusion The CURB-65 score predicted ICU hospitalization and in-hospital mortality better than the qCSI and the BCRSS scores. Also, the qCSI score predicted ICU admission better than the BCRSS score.The predictive effect of the BCRSS score was the lowest. We recommend future studies to evaluate the value and utility of COVID-19 risk classification models.
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Affiliation(s)
- İbrahim Toker
- Department of Emergency Medicine, Kayseri City Hospital,
Kayseri, Turkey
| | - Ayşin Kılınç-Toker
- Department of Infectious Disease and Clinical Microbiology,
Kayseri City Hospital, Kayseri, Turkey
| | - Ayşe Turunç-Özdemir
- Department of Infectious Disease and Clinical Microbiology,
Kayseri City Hospital, Kayseri, Turkey
| | - Mükerrem Altuntaş
- Department of Emergency Medicine, Kayseri City Hospital,
Kayseri, Turkey
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17
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Uruma Y, Manabe T, Fujikura Y, Iikura M, Hojo M, Kudo K. Effect of asthma, COPD, and ACO on COVID-19: A systematic review and meta-analysis. PLoS One 2022; 17:e0276774. [PMID: 36318528 PMCID: PMC9624422 DOI: 10.1371/journal.pone.0276774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction The prevalence of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) in patients with COVID-19 varies, as well as their risks of mortality. The present study aimed to assess the prevalence of asthma, COPD, and ACO as comorbidities, and to determine their risks of mortality in patients with COVID-19 using a systematic review and meta-analysis. Methods We systematically reviewed clinical studies that reported the comorbidities of asthma, COPD, and ACO in patients with COVID-19. We searched various databases including PubMed (from inception to 27 September 2021) for eligible studies written in English. A meta-analysis was performed using the random-effect model for measuring the prevalence of asthma, COPD, and ACO as comorbidities, and the mortality risk of asthma, COPD, and ACO in patients with COVID-19 was estimated. A stratified analysis was conducted according to country. Results One hundred one studies were eligible, and 1,229,434 patients with COVID-19 were identified. Among them, the estimated prevalence of asthma, COPD, and ACO using a meta-analysis was 10.04% (95% confidence interval [CI], 8.79–11.30), 8.18% (95% CI, 7.01–9.35), and 3.70% (95% CI, 2.40–5.00), respectively. The odds ratio for mortality of pre-existing asthma in COVID-19 patients was 0.89 (95% CI, 0.55–1.4; p = 0.630), while that in pre-existing COPD in COVID-19 patients was 3.79 (95% CI, 2.74–5.24; p<0.001). France showed the highest prevalence of asthma followed by the UK, while that of COPD was highest in the Netherlands followed by India. Conclusion Pre-existing asthma and COPD are associated with the incidence of COVID-19. Having COPD significantly increases the risk of mortality in patients with COVID-19. These differences appear to be influenced by the difference of locations of disease pathophysiology and by the daily diagnosis and treatment policy of each country.
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Affiliation(s)
- Yuka Uruma
- Nagoya City University Medical School, Aichi, Japan
| | - Toshie Manabe
- Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
- Nagoya City University West Medical Center, Aichi, Japan
- * E-mail:
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koichiro Kudo
- Yurin Hospital, Tokyo, Japan
- Waseda University, Institute for Asia Human Community, Tokyo, Japan
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18
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Petrucci E, Cofini V, Pizzi B, Cascella M, Sollima L, Calvisi G, Gentili L, Marrocco G, Vittori A, Necozione S, Marinangeli F. Hypopharynx, oropharynx morphology and histology in severe Coronavirus 2 patients treated by noninvasive ventilation: comparison between full-face mask and helmet strategies. Minerva Anestesiol 2022; 88:918-927. [PMID: 36367410 DOI: 10.23736/s0375-9393.22.16434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Non-invasive ventilation may alter the morphology and histology of the upper airway mucosa. This study aimed to investigate the alterations of hypopharynx and oropharynx mucosa, identified during oro-tracheal intubation procedure via video-assisted laryngoscopy, in severe acute respiratory syndrome Coronavirus 2 related, treated by non-invasive ventilation via full-face mask or helmet. METHODS Data of patients affected by Coronavirus 2 admitted to COVID Hospital of L'Aquila (Italy), presenting hypopharynx and oropharynx morphology alterations, requiring oro-tracheal intubation for invasive ventilation and initially treated with non-invasive ventilation were included in the study. The study aimed to investigate the upper airway mucosa alterations using oropharyngeal and hypopharyngeal images and biopsies taken during video-assisted-laryngoscopy. Data from the hypopharynx and oropharynx morphology and histology alterations between non-invasive ventilation via a full-face mask or helmet used during hospitalization were compared. RESULTS From 220 data recorded, 60 patients were included in the study and classified into non-invasive ventilation full-face mask group (30/60) and via helmet group. Comparing data between groups, significant differences were found with respect to hyperemia (77% vs. 20%), laryngeal bleeding ulcerations (87% vs. 13%), and vocal cord edema with >50% narrowing of the tracheal lumen (73% vs. 7%), respectively. The histology examination revealed fibrin-necrotic exudate with extensive necrotic degenerative changes in the sample tissue of the groups. There were not any differences in the duration time of non-invasive ventilation, time from hospitalization and the start of ventilation between groups. CONCLUSIONS The data from this research suggested that there were differences in airway mucosa damages among patients treated with a full-face mask or helmet. Further studies should be planned to understand which non-invasive ventilation support may mitigate upper airway mucosa damages when oro-tracheal intubation is requested for invasive respiratory support.
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Affiliation(s)
- Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy -
| | - Vincenza Cofini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Barbara Pizzi
- Department of Anesthesia and Intensive Care Unit, SS Filippo and Nicola Academic Hospital of Avezzano, L'Aquila, Italy
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Naples, Italy
| | - Laura Sollima
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Giuseppe Calvisi
- Department of Anatomopathology, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Luca Gentili
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gioele Marrocco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Bambino Gesù IRCCS Children Hospital, Rome, Italy
| | - Stefano Necozione
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Franco Marinangeli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Heydari F, Zamani M, Masoumi B, Majidinejad S, Nasr-Esfahani M, Abbasi S, Shirani K, Sheibani Tehrani D, Sadeghi-aliabadi M, Arbab M. Physiologic Scoring Systems in Predicting the COVID-19 Patients' one-month Mortality; a Prognostic Accuracy Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e83. [PMID: 36426162 PMCID: PMC9676706 DOI: 10.22037/aaem.v10i1.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction : It is critical to quickly and easily identify severe coronavirus disease 2019 (COVID-19) patients and predict their mortality. This study aimed to determine the accuracy of the physiologic scoring systems in predicting the mortality of COVID-19 patients. Methods: This prospective cross-sectional study was performed on COVID-19 patients admitted to the emergency department (ED). The clinical characteristics of the participants were collected by the emergency physicians and the accuracy of the Quick Sequential Failure Assessment (qSOFA), Coronavirus Clinical Characterization Consortium (4C) Mortality, National Early Warning Score-2 (NEWS2), and Pandemic Respiratory Infection Emergency System Triage (PRIEST) scores for mortality prediction was evaluated. Results: Nine hundred and twenty-one subjects were included. Of whom, 745 (80.9%) patients survived after 30 days of admission. The mean age of patients was 59.13 ± 17.52 years, and 550 (61.6%) subjects were male. Non-Survived patients were significantly older (66.02 ± 17.80 vs. 57.45 ± 17.07, P< 0.001) and had more comorbidities (diabetes mellitus, respiratory, cardiovascular, and cerebrovascular disease) in comparison with survived patients. For COVID-19 mortality prediction, the AUROCs of PRIEST, qSOFA, NEWS2, and 4C Mortality score were 0.846 (95% CI [0.821-0.868]), 0.788 (95% CI [0.760-0.814]), 0.843 (95% CI [0.818-0.866]), and 0.804 (95% CI [0.776-0.829]), respectively. All scores were good predictors of COVID-19 mortality. Conclusion: All studied physiologic scores were good predictors of COVID-19 mortality and could be a useful screening tool for identifying high-risk patients. The NEWS2 and PRIEST scores predicted mortality in COVID-19 patients significantly better than qSOFA.
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Affiliation(s)
- Farhad Heydari
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Zamani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Babak Masoumi
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Corresponding author: Babak Masoumi; Alzahra Hospital, Sofeh Ave, Keshvari Blvd., Isfahan, Iran. , ORCID: https://orcid.org/0000-0002-7330-5986, Tel: +989121979028
| | - Saeed Majidinejad
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Nasr-Esfahani
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Abbasi
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiana Shirani
- Department of Infectious Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mahsa Sadeghi-aliabadi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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20
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Arora P, Shankar T, Joshi S, Pillai A, Kabi A, Arora RK, Khapre M, Chowdhury N. Prognostication of COVID-19 patients using ROX index and CURB-65 score - A retrospective observational study. J Family Med Prim Care 2022; 11:6006-6014. [PMID: 36618245 PMCID: PMC9810859 DOI: 10.4103/jfmpc.jfmpc_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Coronavirus disease-2019 (COVID-19) disease has overwhelmed the healthcare infrastructure worldwide. The shortage of intensive care unit (ICU) beds leads to longer waiting times and higher mortality for patients. High crowding leads to an increase in mortality, length of hospital stays, and hospital costs for patients. Through an appropriate stratification of patients, rational allocation of the available hospital resources can be accomplished. Various scores for risk stratification of patients have been tried, but for a score to be useful at primary care level, it should be readily available at the bedside and be reproducible. ROX index and CURB-65 are simple bedside scores, requiring minimum equipment, and investigations to calculate. Methods This retrospective, record-based study included adult patients who presented to the ED from May 1, 2020 to November 30, 2020 with confirmed COVID-19 infection. The patient's clinical and demographic details were obtained from the electronic medical records of the hospital. ROX index and CURB-65 score on ED arrival were calculated and correlated with the need for hospitalization and early (14-day) and late (28-day) mortality. Results 842 patients were included in the study. The proportion of patients with mild, moderate and severe disease was 46.3%, 14.9%, and 38.8%, respectively. 55% patients required hospitalization. The 14-day mortality was 8.8% and the 28-day mortality was 20.7%. The AUROC of ROX index for predicting hospitalization was 0.924 (p < 0.001), for 14-day mortality was 0.909 (p < 0.001) and for 28-day mortality was 0.933 (p < 0.001). The AUROC of CURB-65 score for predicting hospitalization was 0.845 (p < 0.001), for 14-day mortality was 0.905 (p < 0.001) and for 28-day mortality was 0.902 (p < 0.001). The cut-off of ROX index for predicting hospitalization was ≤18.634 and for 14-day mortality was ≤14.122. Similar cut-off values for the CURB-65 score were ≥1 and ≥2, respectively. Conclusion ROX index and CURB-65 scores are simple and inexpensive scores that can be efficiently utilised by primary care physicians for appropriate risk stratification of patients with COVID-19 infection.
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Affiliation(s)
- Poonam Arora
- Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India
| | - Takshak Shankar
- Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Takshak Shankar, Department of Emergency Medicine, C-Block, AIIMS Rishikesh, Uttarakhand, India. E-mail:
| | - Shrirang Joshi
- Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India
| | - Aadya Pillai
- Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India
| | - Ankita Kabi
- Department of Emergency Medicine, AIIMS Rishikesh, Uttarakhand, India
| | | | - Meenakshi Khapre
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
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21
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MuLBSTA skorunun SARS-CoV-2 pnömonili hospitalize hastalarda kritik klinik sonuçları öngörmedeki prediktif değerinin incelenmesi. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2022. [DOI: 10.21673/anadoluklin.1132734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Giriş:MuLBSTA (Multilobar infiltrasyon, Lenfositopeni, Bakteriyel koenfeksiyon, Sigara öyküsü, hiperTansiyon ve Yaş> 65) skoru, viral pnömonisi olan hastaları beklenen mortaliteye göre sınıflandırmak için kullanılan bir klinik tahmin kuralıdır. Hastanede yatan Sars-Cov-2 hastalarında kötü klinik sonuçlar için MuLBSTA'nın prediktif performansını PSI, CURB-65 ve qSOFA ile karşılaştırdık.
Metot:Bu çalışma 11 Mart 2020 ile 31 Mayıs 2020 tarihleri arasında üçüncü basamak bir üniversite hastanesinde yatan Sars-Cov-2'li hastalar üzerinde geriye dönük yapıldı. SARS-Cov-2 testi pozitif çıkan 900 hastadan 271'i çalışmaya dahil edildi. Tüm hastalarda 30 günlük mortalite, YBÜ ihtiyacı, mekanik ventilasyon gereksinimi ve ARDS gelişimini değerlendirmek için MuLBSTA, PSI, CURB65 ve qSOFA skoru kullanıldı. 30 günlük mortalite için prognostik faktörler de analiz edildi.
Bulgular:Hastanede yatan 271 hastanın 150'si (%55.3) erkekti. Ortalama yaş 54.2 ± 15.4 yıldı. 30 günlük ölüm oranı %10,7 idi. Çalışmaya dahil edilen hastalardan; 39 hasta (%14,3) yoğun bakıma yatırıldı, 32 hasta (%11,8) mekanik ventilatör desteği aldı ve 23 hasta (%8,4) ARDS tanısı aldı. Mortaliteyi tahmin etmede MuLBSTA, PSI, CURB-65 ve qSOFA skorlarının alıcı işletim karakteristik eğrisi altında kalan alan(AUROC) değerleri sırasıyla 0.877 (%95 CI 0.832 0.914), 0.853 (%95 CI 0.806-0.893), 0.769 (95% CI 0,714-0,817) ve 0,769 (95% CI 0,715-0,818). MuLBSTA puanı, diğer tahmin puanlarına kıyasla daha yüksek bir AUROC değeri gösterdi. MuLBSTA ve PSI skorları, YBÜ ihtiyacı, mekanik ventilasyon gereksinimive ARDS gelişimi olan hastaları belirlemede CURB-65 ve qSOFA skorlarından daha iyi performans gösterdi.
Sonuç:MuLBSTA skoru, hastanede yatan Sars-Cov-2 hastalarında kötü klinik sonuçları tahmin etmek için etkili bir araçtır. Kullanımını doğrulamak için daha fazla çalışmaya ihtiyaç vardır.
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22
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The Low Expression of Fc-Gamma Receptor III (CD16) and High Expression of Fc-Gamma Receptor I (CD64) on Neutrophil Granulocytes Mark Severe COVID-19 Pneumonia. Diagnostics (Basel) 2022; 12:diagnostics12082010. [PMID: 36010361 PMCID: PMC9407138 DOI: 10.3390/diagnostics12082010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Abstract
Hyperinflammation through neutrophil granulocytes contributes to disease severity in COVID-19 pneumonia and promotes acute lung failure. Understanding the mechanisms of the dysregulations within the myeloid cell compartment may help to improve therapies for severe COVID-19 infection. Here, we investigated the immunopathological characteristics of circulating neutrophil granulocytes and monocytes in 16 patients with COVID-19 pneumonia by multiparameter flow cytometry in comparison to 9 patients with pulmonary infiltrates but without COVID-19. We correlated the immunophenotypes with the scores of the severity-of-disease classification system, APACHE-II. We found that the mean fluorescence intensity (MFI) of CD15, which is important for the transendothelial migration, was significantly reduced in the patients with COVID-19 (difference ± SD; 295.70 ± 117.50 MFI; p = 0.02). In addition, the granularity was significantly lower in the neutrophil granulocytes of patients with COVID-19 (difference ± SD; 1.11 ± 0.43 side-scatter ratio; p = 0.02). Moreover, the Fc-gamma receptor III (CD16) and Fc-gamma receptor I (CD64) on the neutrophil granulocytes were expressed discordantly with COVID-19 severity. CD16 correlated as inversely proportional (ρ = (−)0.72; 95% CI (−)0.92–(−)0.23; p = 0.01) and CD64 as proportional (ρ = 0.76; 95% CI 0.31–0.93; p = 0.01) with the APACHE-II scores of the patients. We conclude that the deviant expression of the Fc-gamma receptors might play role in a dysregulated antibody-mediated phagocytosis in severe cases of COVID-19 pneumonia.
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23
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Martin J, Gaudet-Blavignac C, Lovis C, Stirnemann J, Grosgurin O, Leidi A, Gayet-Ageron A, Iten A, Carballo S, Reny JL, Darbellay-Fahroumand P, Berner A, Marti C. Comparison of prognostic scores for inpatients with COVID-19: a retrospective monocentric cohort study. BMJ Open Respir Res 2022; 9:9/1/e001340. [PMID: 36002181 PMCID: PMC9412043 DOI: 10.1136/bmjresp-2022-001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background The SARS-CoV-2 pandemic led to a steep increase in hospital and intensive care unit (ICU) admissions for acute respiratory failure worldwide. Early identification of patients at risk of clinical deterioration is crucial in terms of appropriate care delivery and resource allocation. We aimed to evaluate and compare the prognostic performance of Sequential Organ Failure Assessment (SOFA), Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Uraemia, Respiratory Rate, Blood Pressure and Age ≥65 (CURB-65), Respiratory Rate and Oxygenation (ROX) index and Coronavirus Clinical Characterisation Consortium (4C) score to predict death and ICU admission among patients admitted to the hospital for acute COVID-19 infection. Methods and analysis Consecutive adult patients admitted to the Geneva University Hospitals during two successive COVID-19 flares in spring and autumn 2020 were included. Discriminative performance of these prediction rules, obtained during the first 24 hours of hospital admission, were computed to predict death or ICU admission. We further exluded patients with therapeutic limitations and reported areas under the curve (AUCs) for 30-day mortality and ICU admission in sensitivity analyses. Results A total of 2122 patients were included. 216 patients (10.2%) required ICU admission and 303 (14.3%) died within 30 days post admission. 4C score had the best discriminatory performance to predict 30-day mortality (AUC 0.82, 95% CI 0.80 to 0.85), compared with SOFA (AUC 0.75, 95% CI 0.72 to 0.78), qSOFA (AUC 0.59, 95% CI 0.56 to 0.62), CURB-65 (AUC 0.75, 95% CI 0.72 to 0.78) and ROX index (AUC 0.68, 95% CI 0.65 to 0.72). ROX index had the greatest discriminatory performance (AUC 0.79, 95% CI 0.76 to 0.83) to predict ICU admission compared with 4C score (AUC 0.62, 95% CI 0.59 to 0.66), CURB-65 (AUC 0.60, 95% CI 0.56 to 0.64), SOFA (AUC 0.74, 95% CI 0.71 to 0.77) and qSOFA (AUC 0.59, 95% CI 0.55 to 0.62). Conclusion Scores including age and/or comorbidities (4C and CURB-65) have the best discriminatory performance to predict mortality among inpatients with COVID-19, while scores including quantitative assessment of hypoxaemia (SOFA and ROX index) perform best to predict ICU admission. Exclusion of patients with therapeutic limitations improved the discriminatory performance of prognostic scores relying on age and/or comorbidities to predict ICU admission.
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Affiliation(s)
- Jeremy Martin
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - Christophe Gaudet-Blavignac
- Department of Medical Imaging and Medical Information Sciences, Geneva University Hospitals, Geneve, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medical Imaging and Medical Information Sciences, Geneva University Hospitals, Geneve, Switzerland
| | - Jérôme Stirnemann
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Olivier Grosgurin
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Antonio Leidi
- Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Angèle Gayet-Ageron
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Division of Clinical Epidemiology, Geneva University Hospitals, Geneve, Switzerland
| | - Anne Iten
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Infection Control Program, Geneva University Hospitals, Geneve, Switzerland
| | - Sebastian Carballo
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Jean-Luc Reny
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Pauline Darbellay-Fahroumand
- Faculty of Medicine, University of Geneva, Geneve, Switzerland.,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Amandine Berner
- Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Christophe Marti
- Faculty of Medicine, University of Geneva, Geneve, Switzerland .,Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
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24
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Hassan S, Ramspek CL, Ferrari B, van Diepen M, Rossio R, Knevel R, la Mura V, Artoni A, Martinelli I, Bandera A, Nobili A, Gori A, Blasi F, Canetta C, Montano N, Rosendaal FR, Peyvandi F. External validation of risk scores to predict in-hospital mortality in patients hospitalized due to coronavirus disease 2019. Eur J Intern Med 2022; 102:63-71. [PMID: 35697562 PMCID: PMC9174149 DOI: 10.1016/j.ejim.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) presents an urgent threat to global health. Prediction models that accurately estimate mortality risk in hospitalized patients could assist medical staff in treatment and allocating limited resources. AIMS To externally validate two promising previously published risk scores that predict in-hospital mortality among hospitalized COVID-19 patients. METHODS Two prospective cohorts were available; a cohort of 1028 patients admitted to one of nine hospitals in Lombardy, Italy (the Lombardy cohort) and a cohort of 432 patients admitted to a hospital in Leiden, the Netherlands (the Leiden cohort). The endpoint was in-hospital mortality. All patients were adult and tested COVID-19 PCR-positive. Model discrimination and calibration were assessed. RESULTS The C-statistic of the 4C mortality score was good in the Lombardy cohort (0.85, 95CI: 0.82-0.89) and in the Leiden cohort (0.87, 95CI: 0.80-0.94). Model calibration was acceptable in the Lombardy cohort but poor in the Leiden cohort due to the model systematically overpredicting the mortality risk for all patients. The C-statistic of the CURB-65 score was good in the Lombardy cohort (0.80, 95CI: 0.75-0.85) and in the Leiden cohort (0.82, 95CI: 0.76-0.88). The mortality rate in the CURB-65 development cohort was much lower than the mortality rate in the Lombardy cohort. A similar but less pronounced trend was found for patients in the Leiden cohort. CONCLUSION Although performances did not differ greatly, the 4C mortality score showed the best performance. However, because of quickly changing circumstances, model recalibration may be necessary before using the 4C mortality score.
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Affiliation(s)
- Shermarke Hassan
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Chava L Ramspek
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Barbara Ferrari
- U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raffaella Rossio
- U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rachel Knevel
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Vincenzo la Mura
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Artoni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ida Martinelli
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Gori
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; Infectious Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ciro Canetta
- Department of Medicine, High Care Internal Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Medicina Generale Immunologia e Allergologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Flora Peyvandi
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Francesco Sforza 35, Milan 20122, Italy; U.O.C. Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Giner-Galvañ V, Pomares-Gómez FJ, Quesada JA, Rubio-Rivas M, Tejada-Montes J, Baltasar-Corral J, Taboada-Martínez ML, Sánchez-Mesa B, Arnalich-Fernández F, Del Corral-Beamonte E, López-Sampalo A, Pesqueira-Fontán PM, Fernández-Garcés M, Gómez-Huelgas R, Ramos-Rincón JM. C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19. Biomedicines 2022; 10:biomedicines10061393. [PMID: 35740416 PMCID: PMC9219981 DOI: 10.3390/biomedicines10061393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551−0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001−1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865−0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188−1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course.
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Affiliation(s)
- Vicente Giner-Galvañ
- Department of Internal Medicine, Hospital Clínico Universitario San Juan de Alicante, 03550 Alicante, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46020 Valencia, Spain;
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
- Correspondence: or ; Tel.: +34-680-588-421
| | - Francisco José Pomares-Gómez
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), 46020 Valencia, Spain;
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
- Department of Endocrinology, Hospital Clínico Universitario San Juan de Alicante, 03550 Alicante, Spain
| | - José Antonio Quesada
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, 08097 L’Hospitalet de Llobregat, Spain;
| | - Javier Tejada-Montes
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | | | | | - Blanca Sánchez-Mesa
- Department of Internal Medicine, Hospital Costa del Sol, 20603 Marbella, Spain;
| | | | | | - Almudena López-Sampalo
- Department of Internal Medicine, Regional University Hospital of Málaga, 29010 Málaga, Spain; (A.L.-S.); (R.G.-H.)
- Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29590 Málaga, Spain
| | - Paula María Pesqueira-Fontán
- Department of Internal Medicine, Complejo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Mar Fernández-Garcés
- Department of Internal Medicine, Doctor Peset University Hospital, 46017 Valencia, Spain;
| | - Ricardo Gómez-Huelgas
- Department of Internal Medicine, Regional University Hospital of Málaga, 29010 Málaga, Spain; (A.L.-S.); (R.G.-H.)
- Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), 29590 Málaga, Spain
| | - José Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Medicine School, University Miguel Hernández, 03550 Alicante, Spain; (J.A.Q.); (J.M.R.-R.)
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Kibar Akilli I, Bilge M, Uslu Guz A, Korkusuz R, Canbolat Unlu E, Kart Yasar K. Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia. J Pers Med 2022; 12:801. [PMID: 35629223 PMCID: PMC9144423 DOI: 10.3390/jpm12050801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961−0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.
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Affiliation(s)
- Isil Kibar Akilli
- Department of Pulmonary Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey
| | - Muge Bilge
- Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey;
| | - Arife Uslu Guz
- Department of Pulmonary Disease, Mehmet Akif Ersoy Training and Research Hospital, University of Health Sciences, Turgut Ozal Boulevard, No. 11, Kucukcekmece, Istanbul 34303, Turkey;
| | - Ramazan Korkusuz
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Esra Canbolat Unlu
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Kadriye Kart Yasar
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
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Georgakopoulou VE, Vlachogiannis NI, Basoulis D, Eliadi I, Georgiopoulos G, Karamanakos G, Makrodimitri S, Samara S, Triantafyllou M, Voutsinas PM, Ntziora F, Psichogiou M, Samarkos M, Sfikakis PP, Sipsas NV. A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients. J Clin Med 2022; 11:jcm11071810. [PMID: 35407418 PMCID: PMC8999885 DOI: 10.3390/jcm11071810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020−20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (n = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820−0.926). This score performed well in an unselected patient cohort (n = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683−0.753), as well as in a mixed cohort (n = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656−0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.
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Affiliation(s)
- Vasiliki E. Georgakopoulou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Nikolaos I. Vlachogiannis
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Dimitrios Basoulis
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Irene Eliadi
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Georgios Karamanakos
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Sotiria Makrodimitri
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Stamatia Samara
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Maria Triantafyllou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Pantazis M. Voutsinas
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Fotinie Ntziora
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Mina Psichogiou
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Michael Samarkos
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (N.I.V.); (F.N.); (P.P.S.)
| | - Nikolaos V. Sipsas
- Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.E.G.); (D.B.); (I.E.); (G.K.); (S.M.); (S.S.); (M.T.); (P.M.V.); (M.P.); (M.S.)
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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28
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Akman C, Bardakçı O, Daş M, Akdur G, Akdur O. The Effectiveness of National Early Warning Score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and Elixhauser Comorbidity Index Scores in Predicting Mortality Due to COVID-19 in Elderly Patients. Cureus 2022; 14:e23012. [PMID: 35464509 PMCID: PMC9001189 DOI: 10.7759/cureus.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: As the mortality rate in coronavirus disease 2019 (COVID-19) patients older than 65 years is considerable, evaluation of in-hospital mortality is crucial. This study aimed to evaluate in-hospital mortality in COVID-19 patients older than 65 years using the National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (q-SOFA), Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Methods: This retrospective study included data from 480 patients with confirmed COVID-19 and age over 65 years who were evaluated in a university emergency department in Turkey. Data from eligible but deceased COVID-19 patients was also included. NEWS, q-SOFA, CCI, and ECI scores were retrospectively calculated. All clinical data was accessed from the information management system of the hospital, retrieved, and analyzed. Results: In-hospital mortality was seen in 169 patients (169/480). Low oxygen saturation, high C-reactive protein (CRP) and urea levels, and high q-SOFA and ECI scores helped us identify mortality in high-risk patients. A statistically significant difference was found in mortality estimation between q-SOFA and ECI (p <0.001), respectively. Conclusion: Q-SOFA and ECI can be used both easily and practically in the early diagnosis of in-hospital mortality in COVID-19 positive patients over 65 years of age admitted to the emergency department. Low oxygen saturation, high CRP and urea levels, and high q-SOFA and ECI scores are helpful in identifying high-risk patients.
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Miller JL, Tada M, Goto M, Chen H, Dang E, Mohr NM, Lee S. Prediction models for severe manifestations and mortality due to COVID-19: A systematic review. Acad Emerg Med 2022; 29:206-216. [PMID: 35064988 DOI: 10.1111/acem.14447] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Throughout 2020, the coronavirus disease 2019 (COVID-19) has become a threat to public health on national and global level. There has been an immediate need for research to understand the clinical signs and symptoms of COVID-19 that can help predict deterioration including mechanical ventilation, organ support, and death. Studies thus far have addressed the epidemiology of the disease, common presentations, and susceptibility to acquisition and transmission of the virus; however, an accurate prognostic model for severe manifestations of COVID-19 is still needed because of the limited healthcare resources available. OBJECTIVE This systematic review aims to evaluate published reports of prediction models for severe illnesses caused COVID-19. METHODS Searches were developed by the primary author and a medical librarian using an iterative process of gathering and evaluating terms. Comprehensive strategies, including both index and keyword methods, were devised for PubMed and EMBASE. The data of confirmed COVID-19 patients from randomized control studies, cohort studies, and case-control studies published between January 2020 and May 2021 were retrieved. Studies were independently assessed for risk of bias and applicability using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). We collected study type, setting, sample size, type of validation, and outcome including intubation, ventilation, any other type of organ support, or death. The combination of the prediction model, scoring system, performance of predictive models, and geographic locations were summarized. RESULTS A primary review found 445 articles relevant based on title and abstract. After further review, 366 were excluded based on the defined inclusion and exclusion criteria. Seventy-nine articles were included in the qualitative analysis. Inter observer agreement on inclusion 0.84 (95%CI 0.78-0.89). When the PROBAST tool was applied, 70 of the 79 articles were identified to have high or unclear risk of bias, or high or unclear concern for applicability. Nine studies reported prediction models that were rated as low risk of bias and low concerns for applicability. CONCLUSION Several prognostic models for COVID-19 were identified, with varying clinical score performance. Nine studies that had a low risk of bias and low concern for applicability, one from a general public population and hospital setting. The most promising and well-validated scores include Clift et al.,15 and Knight et al.,18 which seem to have accurate prediction models that clinicians can use in the public health and emergency department setting.
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Affiliation(s)
- Jamie L. Miller
- University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Masafumi Tada
- Department of Health Promotion and Human Behavior School of Public Health, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Michihiko Goto
- Division of Infectious Diseases, Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Hao Chen
- University of Iowa Iowa City Iowa USA
| | | | - Nicholas M. Mohr
- Department of Emergency Medicine, Department of Anesthesia, Department of Epidemiology University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Sangil Lee
- Department of Emergency Medicine The University of Iowa Carver College of Medicine Iowa City Iowa USA
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30
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Garrafa E, Vezzoli M, Ravanelli M, Farina D, Borghesi A, Calza S, Maroldi R. Early prediction of in-hospital death of COVID-19 patients: a machine-learning model based on age, blood analyses, and chest x-ray score. eLife 2021; 10:70640. [PMID: 34661530 PMCID: PMC8550757 DOI: 10.7554/elife.70640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
An early-warning model to predict in-hospital mortality on admission of COVID-19 patients at an emergency department (ED) was developed and validated using a machine-learning model. In total, 2782 patients were enrolled between March 2020 and December 2020, including 2106 patients (first wave) and 676 patients (second wave) in the COVID-19 outbreak in Italy. The first-wave patients were divided into two groups with 1474 patients used to train the model, and 632 to validate it. The 676 patients in the second wave were used to test the model. Age, 17 blood analytes, and Brescia chest X-ray score were the variables processed using a random forests classification algorithm to build and validate the model. Receiver operating characteristic (ROC) analysis was used to assess the model performances. A web-based death-risk calculator was implemented and integrated within the Laboratory Information System of the hospital. The final score was constructed by age (the most powerful predictor), blood analytes (the strongest predictors were lactate dehydrogenase, D-dimer, neutrophil/lymphocyte ratio, C-reactive protein, lymphocyte %, ferritin std, and monocyte %), and Brescia chest X-ray score (https://bdbiomed.shinyapps.io/covid19score/). The areas under the ROC curve obtained for the three groups (training, validating, and testing) were 0.98, 0.83, and 0.78, respectively. The model predicts in-hospital mortality on the basis of data that can be obtained in a short time, directly at the ED on admission. It functions as a web-based calculator, providing a risk score which is easy to interpret. It can be used in the triage process to support the decision on patient allocation.
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Affiliation(s)
- Emirena Garrafa
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Laboratory, Brescia, Italy
| | - Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,ASST Spedali Civili di Brescia, Department of Radiology, Brescia, Italy
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31
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Ramos-Rincón JM, Bernabeu-Whittel M, Fiteni-Mera I, López-Sampalo A, López-Ríos C, García-Andreu MDM, Mancebo-Sevilla JJ, Jiménez-Juan C, Matía-Sanz M, López-Quirantes P, Rubio-Rivas M, Paredes-Ruiz D, González-San-Narciso C, González-Vega R, Sanz-Espinosa P, Hernández-Milián A, Gonzalez-Noya A, Gil-Sánchez R, Boixeda R, Alcalá-Pedrajas JN, Palop-Cervera M, Cortés-Rodríguez B, Guisado-Espartero ME, Mella-Pérez C, Gómez-Huelgas R. Clinical features and risk factors for mortality among long-term care facility residents hospitalized due to COVID-19 in Spain. J Gerontol A Biol Sci Med Sci 2021; 77:e138-e147. [PMID: 34626477 DOI: 10.1093/gerona/glab305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 severely impacted older adults and long-term care facility (LTCF) residents. Our primary aim was to describe differences in clinical and epidemiological variables, in-hospital management, and outcomes between LTCF residents and community-dwelling older adults hospitalized with COVID-19. The secondary aim was to identify risk factors for mortality due to COVID-19 in hospitalized LTCF residents. METHODS This is a cross-sectional analysis within a retrospective cohort of hospitalized patients≥75 years with confirmed COVID-19 admitted to 160 Spanish hospitals. Differences between groups and factors associated with mortality among LTCF residents were assessed through comparisons and logistic regression analysis. RESULTS Of 6,189 patients≥75 years, 1,185 (19.1%) were LTCF residents and 4,548 (73.5%) were community-dwelling. LTCF residents were older (median: 87.4 vs. 82.1 years), mostly female (61.6% vs. 43.2%), had more severe functional dependence (47.0% vs 7.8%), more comorbidities (Charlson Comorbidity Index: 6 vs 5), had dementia more often (59.1% vs. 14.4%), and had shorter duration of symptoms (median: 3 vs 6 days) than community-dwelling patients (all, p<.001). Mortality risk factors in LTCF residents were severe functional dependence (aOR:1.79;95%CI:1.13-2.83;p=.012), dyspnea (1.66;1.16-2.39;p=.004), SatO2<94% (1.73;1.27-2.37;p=.001), temperature≥37.8ºC (1.62;1.11-2.38; p=.013); qSOFA index≥2 (1.62;1.11-2.38;p=.013), bilateral infiltrates (1.98;1.24-2.98;p<.001), and high C-reactive protein (1.005;1.003-1.007;p<.001). In-hospital mortality was initially higher among LTCF residents (43.3% vs 39.7%), but lower after adjusting for sex, age, functional dependence, and comorbidities (aOR:0.74,95%CI:0.62-0.87;p<.001). CONCLUSION Basal functional status and COVID-19 severity are risk factors of mortality in LTCF residents. The lower adjusted mortality rate in LTCF residents may be explained by earlier identification, treatment, and hospitalization for COVID-19.
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Affiliation(s)
| | - Máximo Bernabeu-Whittel
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain.,Medicine Department, University of Seville, Sevilla, Spain
| | | | - Almudena López-Sampalo
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carmen López-Ríos
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | | | - Juan-José Mancebo-Sevilla
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Carlos Jiménez-Juan
- Internal Medicine Department. Virgen del Rocío University Hospital, Seville, Spain
| | - Marta Matía-Sanz
- Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Pablo López-Quirantes
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department. Bellvitge University Hospital- -IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Diana Paredes-Ruiz
- Internal Medicine Department. 12 Octubre University Hospital, Madrid, Spain
| | | | - Rocío González-Vega
- Internal Medicine Department, Costa del Sol Hospital, Marbella (Malaga), Spain
| | - Pablo Sanz-Espinosa
- Internal Medicine Department. Rio Hortega University Hospital, Valladolid, Spain
| | | | - Amara Gonzalez-Noya
- Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain
| | | | - Ramon Boixeda
- Internal Medicine Department. Mataró Hospital, Mataró (Barcelona), Spain
| | | | - Marta Palop-Cervera
- Internal Medicine Department. Sagunto University Hospital, Sagunto (Valencia), Spain
| | | | | | - Carmen Mella-Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, (Ferrol) A Coruna, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department. Málaga Regional University Hospital- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Medicine Department, University of Malaga, Malaga, Spain
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Doğanay F, Ak R. Performance of the CURB-65, ISARIC-4C and COVID-GRAM scores in terms of severity for COVID-19 patients. Int J Clin Pract 2021; 75:e14759. [PMID: 34455674 PMCID: PMC8646358 DOI: 10.1111/ijcp.14759] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the COVID-19 pandemic, difficulties have been experienced in the provision of healthcare services because of excessive patient admissions to hospitals and emergency departments. It has become important to use clear and objective criteria for the early diagnosis of patients with high-risk classification and clinical worsening risk. OBJECTIVE The aim of this study was to assess the prognostic accuracy of CURB-65, ISARIC-4C and COVID-GRAM scores in patients hospitalised for COVID-19 and to compare the scoring systems in terms of predicting in-hospital mortality and intensive care unit requirement. METHODS The files of all COVID-19 patients over the age of 18 who were admitted to the emergency department and hospitalised between September 1, 2020 and December 1, 2020 were retrospectively scanned. The area under the receiver operating characteristic curve and Youden J Index were used to compare scoring systems for predicting in-hospital mortality and intensive care requirement. RESULTS There were 481 patients included in this study. The median age of the patients was 67 (52-79). In terms of in-hospital mortality, the AUC of CURB-65, ISARIC-4C and COVID-GRAM were 0.846, 0.784 and 0.701 respectively. In terms of intensive care requirement, the AUC of CURB-65, ISARIC-4C and COVID-GRAM were 0.898, 0.797 and 0.684 respectively. In our study, Youden's J indexes of CURB-65, ISARIC-4C and COVID-GRAM scores were found to be 0.59, 0.27 and 0.01 respectively, for mortality prediction of COVID-19 patients. Whereas Youden's J indexes were found to be 0.63, 0.26 and 0.01 respectively for determining intensive care requirement. CONCLUSIONS Among the scoring systems assessed, CURB-65 score had better performance in predicting in-hospital mortality and ICU requirement in COVID-19 patients. ISARIC-4C has been found successful in identifying low-risk patients and the use of the ISARIC-4C score with CURB-65 increases the accuracy of risk assessment.
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Affiliation(s)
- Fatih Doğanay
- Department of Emergency MedicineEdremit State HospitalBalıkesirTurkey
| | - Rohat Ak
- Department of Emergency MedicineDr. Lütfi Kırdar Kartal Eğitim ve Araştırma HastanesiIstanbulTurkey
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Corica B, Romiti GF. Assessing inflammatory status in COVID-19: a role in the pandemic? Intern Emerg Med 2021; 16:1423-1425. [PMID: 33772394 PMCID: PMC7996121 DOI: 10.1007/s11739-021-02706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Lozano-Montoya I, Quezada-Feijoo M, Jaramillo-Hidalgo J, Garmendia-Prieto B, Lisette-Carrillo P, Gómez-Pavón FJ. Mortality risk factors in a Spanish cohort of oldest-old patients hospitalized with COVID-19 in an acute geriatric unit: the OCTA-COVID study. Eur Geriatr Med 2021; 12:1169-1180. [PMID: 34287813 PMCID: PMC8294271 DOI: 10.1007/s41999-021-00541-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
Aim The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Findings Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Message Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19. Purpose To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Design Single-center observational study. Setting and participants Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19. Methods Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Results Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was < 60 in 127 patients (42.8%) and 126 (42.0%) had Charlson Index CI ≥ 3. Most patients (216; 72.7%) were frail (Clinical Frailty Scale ≥ 5) and 134 patients (45.1%) had dementia of some degree. The overall in-hospital mortality rate was 37%. The following factors were associated with higher in-hospital mortality in a multi-variant analysis: CURB-65 score = 3–5 (HR 7.99, 95% CI 3.55–19.96, p < 0.001), incident delirium (HR 1.72, 1.10–2.70, p = 0.017) and dementia (HR 3.01, 95% CI 1.37–6.705, p = 0.017). Protective factors were concurrent use of angiotensin-converting enzyme inhibitors (HR 0.42, 95% CI 0.25–0.72, p = 0.002) or prescription of hydroxychloroquine (HC 0.37 95% CI 0.22–0.62, p < 0.001) treatment during admission. Conclusions and implications Our findings suggest that recognition of geriatric syndromes together with the CURB-65 score may be useful tools to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19.
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Affiliation(s)
- Isabel Lozano-Montoya
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain.
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain.
| | - Maribel Quezada-Feijoo
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
- Servicio de Cardiología, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
| | - Javier Jaramillo-Hidalgo
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Blanca Garmendia-Prieto
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Pamela Lisette-Carrillo
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
| | - Francisco J Gómez-Pavón
- Servicio de Geriatría, Hospital Central de la Cruz Roja San José y Santa Adela, C/Reina Victoria, 24, 28003, Madrid, Spain
- Facultad de Medicina, Universidad Alfonso X el Sabio, Avda. de La Universidad, 1, Villanueva de la Cañada, 28691, Madrid, Spain
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35
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Chen J, Liu B, Du H, Lin H, Chen C, Rao S, Yu R, Wang J, Xue Z, Zhang Y, Xie Y. Performance of CURB-65, PSI, and APACHE-II for predicting COVID-19 pneumonia severity and mortality. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211027083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
No prognostic tools for the prediction of COVID-19 pneumonia severity and mortality are available. We explored whether CURB-65, PSI, and APACHE-II could predict COVID-19 pneumonia severity and mortality. We included 167 patients with confirmed COVID-19 pneumonia in this retrospective study. The severity and 30-day mortality of COVID-19 pneumonia were predicted using PSI, CURB-65, and APACHE-II scales. Kappa test was performed to compare the consistency of the three scales. There was a significant difference in the distribution of the scores of the three scales ( P < 0.001). Patients with PSI class ⩽III, CURB-65 ⩽1, and APACHE-II-I all survived. The ROC analysis showed the areas under the curve of the PSI, CURB-65, and APACHE-II scales were 0.83 (95% CI, 0.74–0.93), 0.80 (95% CI, 0.69–0.90), and 0.83 (95% CI, 0.75–0.92), respectively. Our findings suggest that PSI and CURB-65 might be useful to predict the severity and mortality of COVID-19 pneumonia.
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Affiliation(s)
- Junnian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Bang Liu
- Department of Epidemiology and Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Houwei Du
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Hailong Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Cunrong Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Shanshan Rao
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ranjie Yu
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jingjing Wang
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zhiqiang Xue
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yixian Zhang
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Yanghuang Xie
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, Bonten MMJ, Dahly DL, Damen JAA, Debray TPA, de Jong VMT, De Vos M, Dhiman P, Haller MC, Harhay MO, Henckaerts L, Heus P, Kammer M, Kreuzberger N, Lohmann A, Luijken K, Ma J, Martin GP, McLernon DJ, Andaur Navarro CL, Reitsma JB, Sergeant JC, Shi C, Skoetz N, Smits LJM, Snell KIE, Sperrin M, Spijker R, Steyerberg EW, Takada T, Tzoulaki I, van Kuijk SMJ, van Bussel B, van der Horst ICC, van Royen FS, Verbakel JY, Wallisch C, Wilkinson J, Wolff R, Hooft L, Moons KGM, van Smeden M. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020; 369:m1328. [PMID: 32265220 PMCID: PMC7222643 DOI: 10.1136/bmj.m1328] [Citation(s) in RCA: 1630] [Impact Index Per Article: 407.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review and appraise the validity and usefulness of published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of covid-19 infection or being admitted to hospital with the disease. DESIGN Living systematic review and critical appraisal by the COVID-PRECISE (Precise Risk Estimation to optimise covid-19 Care for Infected or Suspected patients in diverse sEttings) group. DATA SOURCES PubMed and Embase through Ovid, up to 1 July 2020, supplemented with arXiv, medRxiv, and bioRxiv up to 5 May 2020. STUDY SELECTION Studies that developed or validated a multivariable covid-19 related prediction model. DATA EXTRACTION At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist; risk of bias was assessed using PROBAST (prediction model risk of bias assessment tool). RESULTS 37 421 titles were screened, and 169 studies describing 232 prediction models were included. The review identified seven models for identifying people at risk in the general population; 118 diagnostic models for detecting covid-19 (75 were based on medical imaging, 10 to diagnose disease severity); and 107 prognostic models for predicting mortality risk, progression to severe disease, intensive care unit admission, ventilation, intubation, or length of hospital stay. The most frequent types of predictors included in the covid-19 prediction models are vital signs, age, comorbidities, and image features. Flu-like symptoms are frequently predictive in diagnostic models, while sex, C reactive protein, and lymphocyte counts are frequent prognostic factors. Reported C index estimates from the strongest form of validation available per model ranged from 0.71 to 0.99 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.54 to 0.99 in prognostic models. All models were rated at high or unclear risk of bias, mostly because of non-representative selection of control patients, exclusion of patients who had not experienced the event of interest by the end of the study, high risk of model overfitting, and unclear reporting. Many models did not include a description of the target population (n=27, 12%) or care setting (n=75, 32%), and only 11 (5%) were externally validated by a calibration plot. The Jehi diagnostic model and the 4C mortality score were identified as promising models. CONCLUSION Prediction models for covid-19 are quickly entering the academic literature to support medical decision making at a time when they are urgently needed. This review indicates that almost all pubished prediction models are poorly reported, and at high risk of bias such that their reported predictive performance is probably optimistic. However, we have identified two (one diagnostic and one prognostic) promising models that should soon be validated in multiple cohorts, preferably through collaborative efforts and data sharing to also allow an investigation of the stability and heterogeneity in their performance across populations and settings. Details on all reviewed models are publicly available at https://www.covprecise.org/. Methodological guidance as provided in this paper should be followed because unreliable predictions could cause more harm than benefit in guiding clinical decisions. Finally, prediction model authors should adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guideline. SYSTEMATIC REVIEW REGISTRATION Protocol https://osf.io/ehc47/, registration https://osf.io/wy245. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 3 of the original article published on 7 April 2020 (BMJ 2020;369:m1328). Previous updates can be found as data supplements (https://www.bmj.com/content/369/bmj.m1328/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
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Affiliation(s)
- Laure Wynants
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Georg Heinze
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marc M J Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Darren L Dahly
- HRB Clinical Research Facility, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten De Vos
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Electrical Engineering, ESAT Stadius, KU Leuven, Leuven, Belgium
| | - Paul Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Maria C Haller
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ordensklinikum Linz, Hospital Elisabethinen, Department of Nephrology, Linz, Austria
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Palliative and Advanced Illness Research Center and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Liesbet Henckaerts
- Department of Microbiology, Immunology and Transplantation, KU Leuven-University of Leuven, Leuven, Belgium
- Department of General Internal Medicine, KU Leuven-University Hospitals Leuven, Leuven, Belgium
| | - Pauline Heus
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Michael Kammer
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Nina Kreuzberger
- Evidence-Based Oncology, Department I of Internal Medicine and Centre for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Lohmann
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jie Ma
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jamie C Sergeant
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nicole Skoetz
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Luc J M Smits
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Keele, UK
| | - Matthew Sperrin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Medical Library, Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Bas van Bussel
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre+, Maastricht University, Maastricht, Netherlands
| | - Florien S van Royen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jan Y Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Christine Wallisch
- Section for Clinical Biometrics, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Jack Wilkinson
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
- Cochrane Netherlands, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
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